Prostate Cancer Staging: What Is Stage 2
Today's news about Don Imus suffering from stage 2 prostate cancer has made many people asking what is stage 2 prostate cancer. The Stage 2 refers to prostate cancer that is detected by PSA and often digital rectal exam but has not spread to any area of the body. All Stage 2 cancers are confined to the prostate itself.
Let's now look at the prostate cancer staging, but before we analyze stage 1 and stage 2 of prostate cancer let's start from the basics.
Prostate cancer is the most common non-skin cancer among men. According to figures from the American Cancer Society, approximately 186,330 new cases are diagnosed each year. Nearly 26,000 men die each year from prostate cancer. Prostate cancer is rarely diagnosed in men younger than 40 years. It is uncommon in men younger than 50 years.
Prostate cancer is much more common in African American men than in white men. Hispanic men seem to have the same rate of prostate cancer as white men. Still Hispanic men and African American men present with more advanced disease. Usually this is due to factors such as education, income, and cultural.
Many men are diagnosed prior to the presentation of symptoms using the screening blood test PSA. When symptoms do occur they include: increased frequency in urination (especially at night), difficulty urinating, increased urgency, and blood in the urine. None of these symptoms are unique to prostate cancer.
When the prostate cancer has metastasized to other areas of the body, then other symptoms may arise. These symptoms may include weight loss, loss of appetite, bone pain (prostate cancer has a strong tendency to metastasize to the bone), and lower extremity pain and edema (when the blood flow or lymphatics are obstructed due to groin node involvement).
Prostate cancer is a slow growing cancer. Early in the disease, the doubling time is as slow as 2-4 years, but this changes as the tumor grows and becomes more aggressive.
The 2002 TNM staging system is used to stage prostate cancer, as follows:
T = Primary tumor
T0 - No evidence of primary tumor
T1 - Clinically inapparent tumor not palpable or visible by imaging
* T1a - Tumor incidental histologic finding in less than or equal to 5% of tissue resected; Progression over 10 years is uncommon
* T1b - Tumor incidental histologic finding in greater than 5% of tissue resected; Tumor-related death rate of 10% in 10 years
* T1c - Tumor identified by needle biopsy (because of elevated PSA level); tumors found in 1 or both lobes by needle biopsy but not palpable or reliably visible by imaging
T2 - Tumor confined within prostate
* T2a - Tumor involving less than half a lobe; 10-yr metastasis free survival rate of 81%
* T2b - Tumor involving less than or equal to 1 lobe; 10-yr metastasis free survival rate of 58%
* T2c - Tumor involving both lobes; 10-yr metastasis free survival rate of 26%
T3 - Tumor extending through the prostatic capsule; no invasion into the prostatic apex or into, but not beyond, the prostatic capsule. Lymph node metastasis at presentation in 50% and approximately 25% rate of 10-year disease-free survival.
* T3a - Extracapsular extension (unilateral or bilateral)
* T3b - Tumor invading seminal vesicle(s)
T4 - Tumor fixed or invading adjacent structures other than seminal vesicles (eg, bladder neck, external sphincter, rectum, levator muscles, pelvic wall)
The natural history of clinically localized disease varies. Lower-grade tumors having a more indolent course, while some high-grade lesions progress to metastatic disease with relative rapidity.
The basic workup for prostate cancer will include the determining the PSA level. If the physician believes that an elevated PSA level may be due to infection, 4-6 weeks of antibiotics are provided, and then the PSA level is rechecked.
A digital rectal exam will be performed. Suspicious nodules or changes often warrant a biopsy.
Further workup depends on the clinical staging. A higher clinical stage of cancer determined by DRE findings, PSA level, and Gleason score (as determined by biopsy) correlates with an increased risk of extraprostatic spread, and these tests are considered key factors in determining the staging workup and predicting patient prognosis.
Treatment will depend on the stage of the cancer, the age and health of the patient. The most common choices are active surveillance, radiation, and surgery.